IVF Diary Part 7: Day 7 Ultrasound, Tests, and More Drugs

This is Part 7 of the IVF Diary series. I’ll be keeping a diary of all important IVF days, starting from when we first chose to undergo infertility treatment in Prague. Click here to read all other IVF diary posts.

Can’t believe we’re already at the 7th chapter of this journey! Let’s get right to it!

The Clinic

We had our first appointment at the clinic this past Monday. The clinic is located in the city center, in Prague’s Old Town neighborhood, and is easily reached by public transportation. After checking out of the fancy (but free) InterContinental hotel at 11 a.m., we decided to try the Czech version of Uber, called Liftago. We had a 100 CZK promo credit (around $4.50) and the ride from the InterContinental to the Hilton Old Town wound up to be almost exactly that.

Thankfully, we were able to check in early and were upgraded to an Executive Suite on the top floor! Access to the Executive lounge with free food and drinks was also included. Oh, and they also added a free breakfast buffet at the restaurant downstairs. Not bad considering we got this stay using a free-night certificate because of an American Express promotion some time ago.

The clinic is right around the corner from the Hilton and was easy enough to find (the entrance is in a courtyard between buildings). We were greeted by a photo-mosaic mural with pictures of staff members, patients and their babies etc. forming a painted image of what I think is the Prague Castle and Vltava river.

Next up was the reception area. Modern sofas and chairs greeted us as we waited for the receptionist to check my passport to make sure I was really who I said I was. A couple minutes later, we got the “all clear” and were asked to wait on the first floor (up one flight of stairs, the lowest level is called the ground floor) where my IVF coordinator would meet us.

The coordinator was waiting for us and introduced herself. She was about my age, I think. I’m pretty bad at guessing people’s age so I always say “about my age’ for anyone who appears to be between 25 and 35. Her English was great and she was really friendly, making us feel at ease almost instantly.

She informed us that my own doctor was unavailable at the moment and that I’d be meeting with a different doctor who was ready to see me.

The Day 7 Scan

After a bit of small talk (just a little bit, this isn’t the US after all) the doctor dimmed the lights, closed the hospital curtains and asked me to get ready. There was a big flatscreen TV screen on the other side of the curtain that mirrored exactly what the doctor was seeing on the smaller ultrasound screen, so Mr. Frugalcrib got a good view of my ovaries and uterus. Not that exciting, but I’m sure it’s awesome for couples who visit the clinic for their prenatal checkups.

The Endometrial Lining

The doctor started by checking my endometrial lining. Both the thickness and the pattern of the lining are important as a receptive endometrium is a prerequisite for successful implantation of the embryo. How important these things really are is debatable. Most studies1,2,3have found higher pregnancy rates above a certain endometrial thickness threshold, but others reported no significant differences4.

The optimal threshold? Scientists are still not sure. Most agree that the chance of implantation is strongly diminished when the lining is <7 mm on the day of the trigger shot. Ideally, it should be >9 mm. Mine was already >11 mm on Day 7 so it’ll be interesting to see if it will continue to thicken or not.

The Endometrial Pattern

The pattern of the lining can be divided into three categories:

Homogenous, hyperechogenic pattern

Intermediate, iso-echogenic pattern

Multilayered trilaminar (“triple-line”) pattern

Doctors prefer to see a triple-line pattern as it’s indicative of a successfully primed endometrium. I asked the doctor about my pattern and he showed me several black and white stripes, which means that my lining was “trilaminar”. I thought it was hard to see though, but it’s kinda cool to know what to look for.

The Follicle Count

Next up was my right ovary. It showed 6 follicles of various sizes. The doctor measured each one and the IVF coordinator (on Mr. Frugalcrib’s side of the curtain) entered the measurements into the computer. If I recall correctly, the biggest one was 11 mm. I knew from my other scans that my right ovary is a bit lazy compared to the left side, so I was looking forward seeing how my left ovary was doing.

On the left were 9 follicles that were a bit bigger than most of the ones on the right. The doctor measured each one and said he was happy with how my body was responding so far to the low dose of meds.

In total, there were 15 follicles. I hope the majority of them continue to grow and develop into mature oocytes that’ll be ready to harvest within a week.

I was supposed to start Cetrotide on Day 7, but asked to make sure as the lead follicles weren’t big enough to trigger a spontaneous ovulation (>18 mm). The doctor said I could start on Day 8 instead.

Blood draws, Urine Samples and Picking up Meds

Me checking out the IVF clinic waiting room

After the ultrasound, my IVF coordinator took us to the second floor where a phlebotomist took our blood. Just one vial for Mr. Frugalcrib (STD tests) and 4 for me (STD + preoperative exam blood draw to make sure I’m okay undergoing general anesthesia).

They also asked me for a urine sample for even more tests. The obligatory EKG will be carried out on the day of the egg collection. Edit, nope. Had to get it done on Day 10.

Afterwards, it was time to pick up a brand new Gonal-F pen and some Cetrotide. The pharmacy was located on the first floor and my IVF coordinator called the pharmacist to have the meds ready. There, we sat down in an office and went over the Cetrotide instructions with the pharmacist. I watched a couple of tutorials on YouTube so kinda knew what to expect, but it was still good to hear it from a pro as well.

We paid around $300 for the Gonal-F and around $210 for 5 Cetrotide injections. I might need more but didn’t want to buy too many in case they decide to trigger me sooner. The pharmacist also explained that all pharmacies in the Czech Republic will charge the same, since the costs are set to a certain level by law. So there’s no need to shop around.

I also paid about $145 for the pre-op exam, which includes 16 30 blood tests, the urine analysis, and the EKG. Not that bad if you ask me! I’m positive I’d pay a lot more if I had all this done back home in the US.